Comparison of Arginine Hydrochloride and Acetazolamide for the Correction of Metabolic Alkalosis in Pediatric Patients

Am J Ther. 2016 Nov/Dec;23(6):e1469-e1473. doi: 10.1097/MJT.0000000000000147.

Abstract

Metabolic alkalosis is a common acid-base disturbance occurring in critically ill pediatric patients. Acetazolamide and arginine hydrochloride are pharmacologic agents used at our institution for patients refractory to first-line therapy or those unable to tolerate fluid replacement. The objective of this retrospective review was to determine if a course of arginine hydrochloride or acetazolamide was more effective at correcting metabolic alkalosis within a 24-hour period. Patients included received a course of acetazolamide or arginine hydrochloride for metabolic alkalosis with a repeat metabolic panel 18-30 hours after treatment initiation. Exclusion criteria consisted of previous treatment with either drug within 24 hours or a documented metabolic disorder. Efficacy was determined by proportion of patients achieving resolution of metabolic alkalosis (treatment success: serum CO2 <30 mmol/L and Cl >96 mmol/L). Additionally, mean change in serum bicarbonate and chloride concentrations was assessed. Thirty-four patients met inclusion criteria, 19 patients received acetazolamide and 15 patients received arginine hydrochloride. Treatment success was similar in patients receiving acetazolamide and arginine hydrochloride (37% vs. 7%, P = 0.053). Correction of serum bicarbonate was observed in more patients treated with acetazolamide (42% vs. 7%, P = 0.047). Both groups had a similar increase in mean serum chloride concentration (5.7 ± 5.3 vs. 4.4 ± 4.4 mmol/L, P = 0.458). Mean decrease in serum bicarbonate concentration was equivalent between groups (5.6 ± 5.2 vs. 2.8 ± 4.7, mmol/L, P = 0.110). Acetazolamide and arginine hydrochloride appear to be equally effective in correcting metabolic alkalosis in critically ill pediatric patients.

Publication types

  • Comparative Study

MeSH terms

  • Acetazolamide / therapeutic use*
  • Alkalosis / drug therapy*
  • Arginine / therapeutic use*
  • Bicarbonates / blood
  • Carbon Dioxide / blood
  • Carbonic Anhydrase Inhibitors / therapeutic use*
  • Child, Preschool
  • Chlorides / blood
  • Critical Illness
  • Humans
  • Infant
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Bicarbonates
  • Carbonic Anhydrase Inhibitors
  • Chlorides
  • Carbon Dioxide
  • Arginine
  • Acetazolamide